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Health Care—The View From Abroad

Visiting a Chinese hospital often feels like an experiment in free-market fundamentalism. Everything is for sale. At the Peking Union Medical College, for instance, the best public hospital in Beijing, the official queue for an appointment starts forming before dawn—patients bring their own lawn chairs—so anyone who can’t endure the wait, or can afford to skip it, pays a scalper. The scalpers prowl the hospital gates, hawking appointments with specialists for somewhere around twenty times the official fee. Once a patient gets in to see a doctor, another shadow economy kicks in: On top of the formal fee, patients know to provide the doctor a “red envelope” of cash, a kind of pre-service tip to encourage attentive care.

Bad as it is, however, as Chinese health-care reformers looked for ways to repair their system in recent years, they glanced at the American status quo and recoiled. “The United States,” as one typically bewildered piece in the Chinese press put it, “is the strongest of the developed countries, but its record on health care is, in fact, extremely bad.” China has long peered over at the United States with a deep, if grudging, respect for American institutions. But, over the winter, as Chinese observers watched the prospects for American health-care reform begin to crumble, they seemed to regard it as another bleak measure of a superpower past its prime. It was time to look to Europe for ideas and to “give up on America as a teacher.”

On Monday, China awoke to discover that the U.S. had found the will to provide medical coverage to tens of millions of uninsured Americans. The U.S. and China don’t see eye-to-eye on much these days, but, for a brief moment, China seemed to glimpse the old teacher again. Zhao Haijian, a commentator in Guangzhou Daily, wrote today that, as China looks at its health-care reform plans, “paying attention to the health care reforms in the U.S. just might provide some reference and inspiration.”

Evan Osnos joined The New Yorker as a staff writer in 2008, and covers politics and foreign affairs.